T-cell large granular lymphocyte leukemia in solid organ transplant recipients: case series and review of the literature
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T-cell large granular lymphocyte (T-LGL) leukemia is a rare clonal proliferation of cytotoxic lymphocytes rarely described in solid organ transplant (SOT). We reviewed records from 656 kidney transplant recipients in follow-up at our Center from January 1998 to July 2017. In addition, we researched, through PubMed, further reports of T-LGL leukemia in SOT from March 1981 to December 2017. We identified six cases of T-LGL leukemia in our cohort of patients and 10 in the literature. This lymphoproliferative disorder was detected in one combined liver–kidney, one liver and 14–kidney transplant recipients. Median age at presentation was 46.5 years (IQR 39.2–56.9). The disease developed after a median age of 10 years (IQR 4.9–12) from transplantation. Anemia was the most common presentation (62.5%) followed by lymphocytosis (43.7%) and thrombocytopenia (31.2%). Splenomegaly was reported in 43.7% of the patients. Eight patients (50%) who experienced severe symptoms were treated with non-specific immunosuppressive agents. Six of them (75%) had a good outcome, whereas two (25%) remained red blood cell transfusion dependent. No cases progressed to aggressive T-LGL leukemia or died of cancer at the end of follow-up. These results suggest that T-LGL leukemia is a rare but potentially disruptive hematological disorder in the post-transplant period.
KeywordsT-cell large granular lymphocyte leukemia T-LGL Post-transplant lymphoproliferative disorder Anemia Solid organ transplantation
Autoimmune hemolytic anemia
Epstein Barr virus
Glomerular filtration rate
T cell lymphotropic virus
Large granular lymphocyte
Large granular lymphocytes
Monoclonal B cell lymphocytosis
Monoclonal gammopathy of undetermined significance
Inhibitor of mammalian target of rapamycin
Pure red cell aplasia
Post-transplant lymphoproliferative disorder
Solid organ transplant
T-cell large granular lymphocyte
All the Authors listed above met the following criteria recommended by International Committee of Medical Journal Editors. In particular: AG designed study. AG, FF and CE performed the study and wrote the paper. MA, MG, CC collected data. PL, LM and CG analyzed data and reviewed the paper. All Authors approved the final version of the manuscript to be published and were accountable for any part of the work.
The authors declare no funding sources.
Compliance with ethical standards
Conflict of interest
The authors declare no conflicts of interest.
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